Beygui R E, Olcott C, Dalman R L
Department of Surgery, Stanford University School of Medicine, CA, USA.
Ann Vasc Surg. 1997 May;11(3):247-55. doi: 10.1007/s100169900042.
Therapeutic options for subclavian vein thrombosis (SVT) include anticoagulation, thrombolysis, endovascular repair, and direct surgical intervention. The most effective method of treatment remains undetermined. We reviewed our institutional experience over 7 years with SVT patients to compare the results of treatment based on etiology of thrombosis. Nineteen patients suffered SVT secondary to malignancy, catheter placement, radiation, or hypercoagulability. Thirteen were Paget-Schroetter (PSS), or primary effort-related SVT. Patients with dialysis access procedures were excluded. Thrombolysis was initiated in 31/32 patients. Success was defined as complete obliteration of clot. Adjunctive treatment to relieve external compression or improve lumenal contour was performed on 16/32 patients (eight PSS, eight secondary SVT). Success of adjunctive treatment was defined as return to baseline activity without symptoms. Objective follow up (venography or duplex scanning) was included when available. Adjunctive treatment included balloon angioplasty (6), stent placement (5), first rib resection and scalenectomy (4), and vein reconstruction (4). Initial treatment success with thrombolysis was achieved in 26/31 patients (84%). Angioplasty failed in three PSS and three secondary SVT patients. Stent placement was successful in 2/5 patients (both secondary SVT). Surgery was performed only on PSS patients: first rib resection and scalenectomy succeeded 4/4 times, vein reconstruction 2/4. Twenty-eight patients were given long-term therapy with oral anticoagulation with good long-term results. Seven patients experienced complications, including one death. Results of SVT therapy including thrombolysis and oral anticoagulation are very good. Angioplasty and stent placement in secondary SVT patients appears to add little long term benefit. Surgery may improve outcome in selected PSS patients, although the additional benefit could not be determined by the design of this study. Evaluation and treatment limited only to PSS excludes the majority of SVT patients.
锁骨下静脉血栓形成（SVT）的治疗选择包括抗凝、溶栓、血管内修复和直接手术干预。最有效的治疗方法仍未确定。我们回顾了本机构7年来对SVT患者的治疗经验，以比较基于血栓形成病因的治疗结果。19例患者继发于恶性肿瘤、导管置入、放疗或高凝状态而发生SVT。13例为佩吉特-施罗特综合征（PSS），即原发性劳力相关型SVT。接受透析通路手术的患者被排除在外。32例患者中有31例开始进行溶栓治疗。成功定义为血栓完全消失。16/32例患者（8例PSS，8例继发性SVT）接受了辅助治疗以缓解外部压迫或改善管腔轮廓。辅助治疗成功定义为恢复到无症状的基线活动水平。如有条件则进行客观随访（静脉造影或双功超声扫描）。辅助治疗包括球囊血管成形术（6例）、支架置入（5例）、第一肋切除和斜角肌切除术（4例）以及静脉重建（4例）。26/31例患者（84%）通过溶栓取得了初始治疗成功。血管成形术在3例PSS患者和3例继发性SVT患者中失败。支架置入在2/5例患者中成功（均为继发性SVT）。仅对PSS患者进行了手术：第一肋切除和斜角肌切除术4/4成功，静脉重建2/4成功。28例患者接受了口服抗凝的长期治疗，长期效果良好。7例患者出现并发症，包括1例死亡。包括溶栓和口服抗凝在内的SVT治疗结果非常好。继发性SVT患者的血管成形术和支架置入似乎没有长期益处。手术可能会改善部分选定的PSS患者的预后，尽管本研究设计无法确定额外的益处。仅针对PSS进行评估和治疗排除了大多数SVT患者。
